Medical Direction of Anesthesia Services
Background/Summary
Final regulations regarding medical direction of anesthesia
services were published November 2, 1998 (63
Federal Register, text and PDF, 58814-59190). HCFA will
adopt the consensus criteria for the medical direction of anesthesia
services by a physician as developed by the American Society
of Anesthesiology (ASA) and the American Association of Nurse
Anesthetists (AANA). The payment rules are different than for
when the anesthesiologist personally performs the service or
in conjunction with residents as opposed to other qualified
providers, such as CRNA's.
General Payment Rule
Medicare pays for the physician's medical direction of anesthesia
services for one service or two through four concurrent anesthesia
services furnished after December 31, 1998, only if each of
the services meets the condition in section 415.102 (a) and
the following additional conditions:
-
For each patient, the physician:
-
performs a pre-anesthetic examination and evaluation;
-
prescribes the anesthesia plan;
-
personally participates in the most demanding aspects
of the anesthesia plan including, if applicable, induction
and emergence (except teaching physician supervising
residents, must be present for the emergence and the
induction);
-
ensures that any procedure in eh anaesthesia plan that
he or she does not perform are performed by a qualified
individual as defined in operating instructions;
-
monitors the course of anesthesia administration at
frequent intervals;
-
remains physically present and available for immediate
diagnosis and treatment of emergencies; and
-
provides indicated post anaesthesia care.
-
In addition, the physician directs no more than four
anesthesia services concurrently and does not perform
any other services while he/she is directing the single
or concurrent services so that one or more of the conditions
in (a) 1 of this section are not violated.
-
If the physician personally performs the anesthesia service,
the payment rules in 414.46 (c) of this chapter apply.
(Physician personally performs the anesthesia procedure)
Medical Documentation
The physician alone inclusively documents in the patient's
record that the conditions set forth in (a) (1) of this section
have been satisfied, specifically documenting that her/she
performed the pre-anesthetic exam and evaluation, provided
the indicated post-anesthesia care, and was present during
the most demanding procedures, including induction and emergence
where applicable.
Administration Action
Final regulations were published November 2, 1998 (63
Federal Register, text and PDF, 58814-59190).
Contacts
Denise Dodero, Associate Vice President
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
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